Senior Claims Manager/Risk Manager - Professional Liability Program

Position Summary
Analyzes and evaluates complex incident reports and lawsuits, reviews medical records and interviews involved individuals to obtain needed information. Prepares complex investigative analytical reports for Director and Legal Counsel regarding potentially compensable incidents covered by the Self-Insured Professional Liability Program, and other reports as requested by Senior Management. Coordinates case development, case management, and participates in office management.

Job Description

Primary Duties & Responsibilities

• Provides consultation and guidance on healthcare issues such as medical record release, subpoena responses, termination/transfer of care, patient complaints and physician billing issues including accounts in litigation. Arranges for attorneys to attend depositions with physicians when necessary.

• Conducts complex internal claims investigations, plans defense strategies and negotiates disposition of assigned files. Conducts meetings with physicians, analyzes medical record information and event reports; directs approved legal counsel and other legal personnel involved in the defense; approves of expert witness reviews; responds to discovery requests and answers interrogatories; coordinates witness preparations; makes recommendations for resolution of claim; and coordinates meetings with Director, defense counsel and Office of General Counsel to perform decision tree analysis to determine case value. Attends mediation, arbitration and/or trial.

• Communicates in an effective and timely manner to appropriate individuals (i.e. Director of Risk Management, Office of General Counsel, Director of Patient Safety, physician and risk managers of affiliated institutions) the occurrence of adverse events. Represents the University in attendance at debriefings and root cause analyses (RCA) as requested. Advises physicians and others regarding disclosure of adverse events to patients and their family.

• Timely analyzes and reviews complex incident reports and as entered into the Event Reporting System (ERS). Determines which events should have additional investigation and/or be reported to the excess carrier, based on pre-determined insurance criteria. Timely classifies and codes relevant data for computerized claim reporting system (WUNDER). Prepares a factual summary based on the available documentation.

• Coordinates and provides on-line education programs to departments related to Safety and Risk Management issues, including the selection of courses to benefit physicians, nurse practitioners, and physician assistants. In addition, reviews on-line patient education programs (EMMI) for such departments as gastric surgery and plastic surgery.

• Prepares and submits required reports to Department Heads, Office of General Counsel, Director of Risk Management, excess insurance carrier and when applicable, coordinates with external agency investigations, i.e. professional Board inquiries.

• Establishes indemnity and expense reserves based on the reserving policy. Negotiates settlements within authority. Reviews and approves defense counsel related bills.

• Collaborates with the Director of Patient Safety in the development of an institutional culture of safety through the design, development and implementation of systems and processes that improve patient safety; therefore reducing risk to patients, staff and the University; and in the implementation and management of patient safety event reporting and risk management information systems.

Preferred Qualifications

• Analytical ability to evaluate facts and formulate questions in order to define problems and critical events in the medical care rendered.

• General knowledge of The Joint Commission and patient safety standards, diagnosis and treatment of human disease and injury, medical therapies, procedures and standard of medical care.

• Organizational skill with attention to accurate detail in the preparation of written reports.

• Knowledge of methods and techniques of individual case study, recording and file maintenance.

Required Qualifications

Equivalent of BS/BA degree. At least five years’ experience analyzing and interpreting medical or other technical evidence that compares in level of complexity to medical treatment. Prefer experience in presenting information to a group.

Grade
G13

Salary Range
$64,700.00 - $110,500.00 / Annually

The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget.

Questions

For frequently asked questions about the application process, please refer to our External Applicant FAQ .

Accommodation

If you are unable to use our online application system and would like an accommodation, please email [email protected]  or call the dedicated accommodation inquiry number at 314-935-1149 and leave a voicemail with the nature of your request.

Pre-Employment Screening
All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening.

Benefits Statement

Personal

• Up to 22 days of vacation, 10 recognized holidays, and sick time.

• Competitive health insurance packages with priority appointments and lower copays/coinsurance.

• Want to Live Near Your Work and/or improve your commute? Take advantage of our free Metro transit U-Pass for eligible employees. We also offer a forgivable home loan of up to $12,500 for closing costs and a down payment for homes in eligible neighborhoods.

• WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%.

Wellness

• Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!

Family

• We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We’ve got you covered.

• WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us.

For policies, detailed benefits, and eligibility, please visit: https://hr.wustl.edu/benefits/

EEO/AA Statement
Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. It is the University’s policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.

Diversity Statement
Washington University is dedicated to building a diverse community of individuals who are committed to contributing to an inclusive environment – fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply.